https://econtent.hogrefe.com/doi/pdf/10.1024/2674-0052/a000080 - Monday, September 09, 2024 2:21:40 AM - IP Address:157.1.136.8

Original article

Development and validation of
the COVID-19 Anxiety Scale forJapanese elite athletes
Kanami Suzuki1 , Tatsuya Yamaguchi2 , Yasuhisa Tachiya3 , Kaori Eda4,
Tomoyuki Asano5, Yoko Senzaki1, and Kohei Nakajima1
1Sport Clinic, Japan Institute of Sports Sciences, Kita-ku, Tokyo, Japan
2Department of Sports Medicine, Faculty of Medicine and Faculty of Health and Sports Science, Graduate School of Health and Sports

Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
3Department of Sports Medicine and Research, Japan Institute of Sports Sciences, Kita-ku, Tokyo, Japan
4Department of Health and Sports Science, Faculty of Health and Sports Science, Toyo University, Bunkyo-ku, Tokyo, Japan
5Faculty of Human Life and Environment, Nara Women’s University, Nara, Japan

Abstract: Introduction: Japanese elite athletes were affected by the spread of COVID-19 infection. Four years after the pandemic, COVID-19 isstill spreading and subsiding, and it is expected that some athletes are still concerned about COVID-19. Therefore, we developed the COVID-19
Anxiety Scale for Elite Athletes (CAS-EA) to measure COVID-19 anxiety among Japanese elite athletes and to examine its reliability and validity.
Method: This is an observational cross-sectional study. In study 1, a 35-item anxiety questionnaire about COVID-19 was administered to 100
elite athletes on 8/18-9/1/2020. In study 2, 296 elite athletes were asked to respond to the CAS-EA, the Japanese version of State-Trait
Anxiety Inventory (STAI), and the Japanese version of the Fear of Coronavirus Virus Scale (FCV-19S) from 8/31-11/8/2022. Results: In study 1,
an exploratory factor analysis was conducted to create CAS-EA, which consisted of 19 items with four factors: Restrictions, Sport, Practice andAthlete value. The reliability of the scales was examined, confirming a certain internal consistency. In addition, study 2 showed significant
positive correlations with CAS-EA and related scales. In the COVID-19 disaster, psychological stress was more strongly associated with A-trait
than physical stress, a result that could be explained by Spielberger’s Trait-state anxiety theory. Furthermore, CAS-EA scores weresignificantly higher for female than for male, which was consistent with the results of previous studies. Conclusion: An attempt was made tocreate a scale to measure anxiety about COVID-19 in Japanese elite athletes, and a 4-factor, 19-item CAS-EA was created. The reliability andvalidity of the scale were tested and confirmed successfully.
Keywords: COVID-19, anxiety, anxiety scale, scale development, elite athletes

Introduction
Coronavirus disease 2019 (COVID-19) greatly affected thedaily lives and mental health of people around the world [1].
A survey conducted by the Japanese Olympic Committee(JOC) of designated athletes at the time of the COVID-19
emergency declaration revealed that many athletes had
some restrictions on their training. In addition, more than
20% of summer athletes experienced psychological distress [2]. Furthermore, we know that strong restrictions
on interpersonal contact due to infection prevention measures had a significant impact on athletes, forcing some athletes to reconsider the value of athletes in society itself [3].
These previous studies indicated that Japanese elite athletes were affected by the spread of COVID-19 infection.
Although restrictions have been eased, COVID-19 stillaffects athletes’ mental health. Tamm et al. report that

more than a year after the COVID-19 pandemic, despite
the fact that the competitive environment has recovered,anxiety about the future is causing high levels of distressfor many elite athletes [4]. Ehara et al. found that athletes
are anxious about contact with others during practice andon the practice field, even during the restriction relaxation
phase [5]. COVID-19 continues to expand and converge,
and there is no way to predict when a more infectious variant will emerge and restrict competition again. Some athletes are expected to be concerned about COVID-19
because they are in environments where the infection caneasily spread, such as on tours or in group activities.
Several psychometric measures of COVID-19 (in the general population) have been reported [6], including the Fearof Coronavirus-19 Scale [7], a measure of COVID-19 fear,
which has been validated by Midorikawa et al. [8] and is
widely used clinically. On the other hand, no reports ofÓ 2024 The Author(s) Distributed as a Hogrefe OpenMind article
under the license CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0)

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Table 1. Anxiety factors associated with COVID-19 in Japanese Elite athletes
Infection

SalaryLoss of competitive ability

Being unable to practice

Staying at home

Information

Loss of motivation

Being unable to participate in matches

Ability to return toprevious way of life

Team

CareerOlympics/Paralympics

Loneliness due to social
distancing

Excessive infection
counter measures

Reconsidering the value ofathletes

Matches without spectators

anxiety scales for elite Japanese athletes, who are often
placed in rather special situations. Thus, we aimed to createa scale (COVID-19 Anxiety Scale for Elite Athletes; CASEA) for measuring COVID-19-related anxiety in Japaneseelite athletes. We conducted the first survey during the difficult period of athlete activity in the early stages of the
COVID-19 infection spread, when our priority was to understand the actual status of COVID-19 anxiety among elite
athletes in Japan, and we were unable to examine eventhe validity of the scale. Therefore, a second study was conducted to examine the reliability and validity of the CAS-EA.
These were Study 1 and 2, which examined the validity of
the CAS-EA as a measure of anxiety related to the
COVID-19 in Japanese elite athletes. These findings may
assist athletes in COVID-19 disasters. In addition, thesefindings may be useful in the case of other infectious disease
outbreaks, as athletes are in environments where infectious
diseases are more likely to spread.

Methods
Study 1: Creation of the scale
Ethical considerations
Participants were informed about the purpose of the study
and gave written consent. Participants completed questionnaires during visits to the High Performance Sport Center(HPSC) sports clinic for sports injuries, poor physical conditions, menstrual abnormalities, skin conditions, dental
care. The HPSC sports clinic is a clinic attached to the
National Training Center that is available only to athletes
who are national team level Athletes. This study was conducted with the approval of the Ethical Review Committeeof the Japan Institute of Sports Sciences (Approval No.
2020-018).
Survey participants and survey period
This study is an observational cross-sectional study. The
study population consisted of 100 national-level athletes(51 males, 48 females, and 1 no answer) who visited the
HPSC sports clinic between August 18 and September 1,
2020, and agreed to participate in the study.
Survey content
Suzuki et al. [3] conducted an open-ended survey of 55
national team level athletes to determine what concerns
Sports Psychiatry. 2024;3(2):63–69

Japanese elite athletes have during the COVID-19 pandemic. Responses to the question “Please feel free todescribe your concerns about COVID-19” were analyzed
by three sport psychological staff members and one author,
a nurse, using the KJ method by Kawakita (1967), which
revealed that there were 16 anxiety factors (Table 1). Items
that were thought to be representative of each of these 16
anxiety factors were selected by the same four analysts fromthe free-answer questions in the aforementioned previous
study, making a total of 35 items in the questionnaire (seeElectronic Supplementary Material, ESM 1). For each item,
participants were asked to respond using a five-point scale.
Statistical analysis
For the item analysis, the mean and standard deviation of
the 35 CAS-EA draft items were calculated, and items withceiling or floor effects were checked to see, and those thatwere excluded from the subsequent analysis. Then, after
testing the normality of the remaining items, Pearson’s correlation coefficients between each item to see overlapping
content excluded from further analysis.
For the remaining items, an exploratory factor analysis
using the main factor method and Promax rotation was conducted to construct the factor structure. The number of factors was determined based on the fact that these werecomposed of items with factor loadings of 0.4 greater andon interpretability. SPSS ver. 24.0 for Windows was used
for the above analyses.

Study 2: Examination of validity
Ethical considerations
The same procedures were followed as in Study 1. This
study was conducted with the approval of the Ethical
Review Committee of the Japan Institute of Sports Sciences(Approval No.2022-029).
Study participants and study period
Our subjects were 296 national team level athletes who visited the HPSC Sports Clinic for the same purpose as Study 1,
and so on from August 31 to November 8, 2022 and provided
consent to participate in this study.
Survey content
COVID-19 Anxiety Scale for Elite Athletes (CAS-EA)
Using the scale developed in Study 1, the participants wereasked to respond on a 5-point scale. Additionally, at the timeÓ 2024 The Author(s) Distributed as a Hogrefe OpenMind article
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K. Suzuki et al., Development of the COVID-19 Anxiety Scale for Japanese elite athletes

65

of Study 2, the Tokyo Olympic and Paralympic Games hadconcluded. Consequently, the author (nurse) who formulated the CAS-EA, and three sports psychology specialists
collaborated to review the questionnaire. They collectively
decided to modify the statement “I am anxious about not
being able to participate in the Tokyo Olympic and Paralympic Games” to “I am anxious that I won’t be able to participate in a tournament that I had set my sights on.”construct validity. The aforementioned analyses were conducted using SPSS version 24.0 for Windows.

Japanese version of the State-Trait Anxiety Inventory(STAI) [9]This scale is a Japanese adaptation of the STAI (Spielberger
et al., 1970) and comprises two components: the state anxiety scale (A-State), reflecting the intensity of anxiety at thetime of assessment, and the trait anxiety scale (A-Trait),
indicating a predisposition to anxiety as a personality trait.
Both scales share a common structure with 20 questions
and four-point ratings (ranging from 1 to 4 points) [9].

Breakdown of study participantsParticipants’ ages ranged from 20-44 (overall: 25.96 ± 4.91;
males: 25.48 ± 4.39, females: 26.47 ± 5.42). The response
rate was 100% and all data were subjected to statisticalanalysis.

Japanese version of the Fear of Coronavirus-19 Scale(FCV-19S) [10]This is the Japanese version of the FCV-19S [8], a scale thatmeasures fear of COVID-19, a problem unique to the
COVID-19 crisis. The scale consists of seven questions,and respondents provide answers on a five-point scale [7].
Midorikawa et al. hold that a total score of 21 points or moreis an appropriate cutoff value for identifying people whose
fear of COVID-19 is disrupting their daily life [10].
Statistical analysis
The reliability of the factor-analyzed scales was evaluatedby calculating Cronbach’s alpha coefficients. Then for theexamination of criterion linkage validity, Spearman’s correlation coefficients between FCV-19S, STAI, and CAS-EA
were calculated after confirming the normality of the population. We expected CAS-EA scores to be positively correlated with these scales. In addition, since the high FCV19S group was predicted to have significantly higher CASEA scores than the low group, after testing for normality,
Mann-Whitney’s U test was used to confirm the differencein CAS-EA scores between the two groups. Criterion linkage
validity was examined based on these results.
Spielberger, in his Trait-state anxiety theory, showed that
individuals with high A-trait feel more threatened in psychological stress, where personal validity is assessed, thanin physical stress [11]. Because the results of Study 1 allowed
us to interpret the CAS-EA subfactors as physical stress andpsychological stress, we predicted that the A characteristic
would be more strongly associated with psychologicalstress, and we tested this using Spearman’s correlation. In
addition Mann-Whitney’s U test was used to confirm differences in CAS-EA scores by sex and sports type, and results
were compared with those of previous studies to examine

Results
Study 1: Creation of the scale

Item analysis and exploratory factor analysis
For the 35 items listed in the draft version of CAS-EA,
6 items with mean (M) ± standard deviation (SD) less than
1 or more than 5 were deleted. Furthermore, two items thatwere determined to have high correlation coefficients andsignificant overlap were removed.
An exploratory factor analysis using the main factor
method with promax rotation was conducted on the 27
items remaining after the item analysis. A four-factor structure was assumed based on the decay rate of eigenvalues
and interpretability, and the main factor method and promax rotation were used. As a result, 8 items that did notshow sufficient factor loadings (.400) were excluded.
The first factor was named “Restrictions” because it consisted of items detailing concerns about restrictions during
the COVID-19 crisis. The second factor was named “Sport,”
comprised of items related to anxiety about the sport itself,
including motivation and competitive ability. The third factor was named “Practice,” comprised of elements related toanxiety specific to practice, even within competitions. The
fourth factor was named “Athlete value,” comprised of concerns about changes in the nature of sport and the value ofathletes amidst the COVID-19 crisis. The CAS-EA was created in accordance with these four factors, consisting of 19
items in total. Cronbach’s alpha coefficients for the CAS-EA
and each subfactors are shown in Table 2.

Study 2: Examination of validity
Breakdown of study participantsParticipants ranged in age from 16 to 48 years (overall:
24.29 ± 5.23 years; male: 24.47 ± 4.87 years; female:
24.09 ± 5.61 years). The breakdown of sport types was
264 for individual sport athletes and 32 for team sport athletes. The response rate was 100%, but because there was
one missing value in the response to the FCV-19S amongthe 296 participants, 295 participants were used in the analysis using the FCV-19S.

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Table 2. Results of exploratory factor analysis (main factor method, promax rotation)
Factor loadings
1

2

3

4

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Restrictions (α = .827)
I am anxious on a daily basis about being infected with the coronavirus.

.685

.048

.068

.076

I feel anxious when I read or listen to news about the COVID-19 situation.

.653

.097

.056

.168

I have a lot of stress at not being able to see others.

.623

.030

.006

.065

I am anxious about whether we’ll be forced to stay at home again.

.604

.019

.003

.037

I feel anxious when I think about how the current situation might affect future matches.

.591

.042

.219

.174

I am anxious that I won’t be able to participate in a tournament that I had set my sights on.

.485

.158

.006

.080

I am anxious about whether matches will be conducted without any spectators.

.440

.160

.191

.234

Sports (α = .771)
It’s hard for me to stay motivated.

.169

.821

.107

.208

I am losing my passion and goals for my sport.

.159

.792

.033

.089

I feel like there is a gulf between team members and staff.

.006

.637

.140

.183

I am anxious because I can’t share my thoughts and goals with other team members or staff.

.056

.473

.126

.072

I am anxious about whether or not my competitive ability has declined.

.276

.429

.176

.018

.098

.048

.840

.186

Practice (α = .719)
I am anxious because I don’t have access to my usual practice environment.
I am anxious about not being able to practice with other players.

.195

.325

.697

.051

I am anxious that I cannot train with my peers and coach.

.040

.088

.615

.084

Athlete value (α = .588)
I am anxious about how the nature of sports itself might change.

.252

.016

.135

.586

The value and significance of athletes that cannot compete are being called into Question.

.002

.079

.099

.549

I am anxious about my future as an athlete.

.017

.373

.144

.469

I am anxious about my salary and how the COVID-19 situation will affect it.

.408

.043

.253

.444

Inter-factor correlation
F1

.408

F2
F3

.074

.252

.376

.416
.339

F4

Examination of reliability and validity
We calculated Cronbach’s alpha coefficient for CAS-EA
and obtained a value of .918. In addition, we calculated
Cronbach’s alpha coefficient for each subscale. “Factor 1:
Restrictions” had α = .868, “Factor 2: Sport” had α = .758,“Factor 3: Practice” had α = .790, and “Factor 4: Athlete
value” had α = .767. Overall, a certain degree of internalconsistency was confirmed.
The correlation coefficient results between the CAS-EA
and related scales, are reported in Table 3. Significant positive correlations were found between the CAS-EA andrelated scales. In addition, a Mann-Whitney U test was executed with the CAS-EA serving as the dependent variable
and the FCV-19S (categorized by cutoff value) as the independent variable. The findings (Table 4) revealed that athletes surpassing the FCV-19S cutoff exhibited significantly
higher CAS-EA.
Table 3 shows the results of the correlation coefficients
between each subfactor of the CAS-EA and STAI. The correlation coefficients with STAI were higher for the “Sport”
Sports Psychiatry. 2024;3(2):63–69

and “Athlete value” than for the “Restrictions” and “Practice”. In particular, the correlation coefficients between
the A-Trait and the “Restrictions” and “Athlete value” werepositive at .40 or higher.
In addition, Table 5 shows CAS-EA scores by sex andsports type. Females scored significantly higher on the total
scale, “Sport” and “Restrictions” compared to males, andathletes in individual sports scored higher only on “Practice” compared to athletes in team sports.

Discussion
Exploratory factor analysis and reliabilityof CAS-EA
Previous studies have reported isolation, training interruption, loss of income, and career as anxiety factors during the
COVID-19 pandemic [12]. Furthermore, they reported thatthe main sources of anxiety at more than one year afterÓ 2024 The Author(s) Distributed as a Hogrefe OpenMind article
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Table 3. Results of correlation analysis with related scales
STAI
FCV-19S

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CAS-EA score

A-stateA-trait.624**.386**.424**

Restrictions factor score.658**.317**.322**

Sports factor score.471*.395**.430**

Practice factor score.392**.260**.285**

Athlete value factor score.434**.341**.417**

Notes. CAS-EA: COVID-19 Anxiety Scale for Elite Athletes. FCV-19S: Japanese version of the Fear of Coronavirus Virus Scale. STAI: Japanese version of theState-Trait Anxiety Inventory. **p < .01.

Table 4. CAS-EA Scale Scores difference between the two groups
FCV-19S = 21

FCV-19S 5 20

n = 15 (male 7, female 8)
average age 29.00

n = 280 (male 146, Female 134)
average age 24.05

Mean (SD)

Mean (SD)p-value

62.13 (12.25)

42.68 (13.65)< .001***

Restrictions factor score 7 items

24.27 (5.23)

17.32 (6.51)< .001***

Sports factor score 5 items

14.20 (4.00)

9.86 (3.79)< .001***

Practice factor score 3 items

9.73 (3.49)

5.91 (2.72)< .001***

Athlete value factor score 4 items< .001***

CAS-EA score 19 items

13.93 (2.76)

9.59 (3.50)

STAI A-trait score48.47 (8.13)

43.41 (10.14).026*

STAI A-stare score49.20 (8.25)

42.45 (9.99)< .001***

Notes. ***p < .001; *p < .05.

Table 5. Differences in CAS-EA scale scores by Sex and Sports type
Sex
Total n = 296

Male n = 154

Sports typeFemale n = 142

Individual n = 264

Team n = 32

Mean (SD)

Mean (SD)

Mean (SD)p-value

Mean (SD)

Mean (SD)p-value

43.69 (14.21)

42.10 (14.55)

45.41 (13.68).032*

44.14 (14.38)

39.97 (12.23).128

Restrictions factor score 7 items

17.67 (6.61)

16.73 (6.50)

18.68 (6.61).008**

17.80 (6.69)

16.63 (5.91).396

Sports factor score 5 items

10.09 (3.91)

9.67 (4.13)

10.54 (3.61).014*

10.11 (3.95)

9.88 (3.65).831

CAS-EA score 19 items

Practice factor score 3 items

6.12 (2.89)

5.92 (2.88)

6.35 (2.89).138

6.28 (2.94)

4.84 (2.07).008*

Athlete value factor score 4 items

9.81 (3.63)

9.79 (3.86)

9.84 (3.38).794

9.95 (3.67)

8.63 (3.14).053

Notes. **p < .01; *p < .05.

release from confinement were related to the future of the
sport and their sports careers [13]. Similar anxiety factors
to these previous studies were extracted from the resultsof this study. Although the CAS-EA was created immediately after COVID-19 pandemic, the high degree of internalconsistency still observed two years later ensured the reliability of the CAS-EA. While overall anxiety scores were nothigh, athletes with high COVID-19 fear had significantly
higher CAS-EA scores than the other players (Table 4).
The results showed that even after COVID-19, some athletes had concerns about “Restrictions” “Sport” “Practice”
and “Athlete value”. It was suggested that even postCOVID-19, we need to continue to monitor the progress
carefully, keeping in mind that some athletes have concerns
about COVID-19.

Review of the validity of CAS-EA
Examination of criterion linkage validity
FCV-19S showed a moderate correlation with CAS-EA total
score and a weak to moderate correlation with CAS-EA
subfactors. STAI showed moderate correlation with CASEA total score and weak to moderate correlation with
CAS-EA subfactors. These results were in line with the
hypothesis that the CAS-EA would be positively correlatedwith the related measures. Furthermore, athletes who
exceeded the FCV-19S cutoff had significantly higher
CAS-EA, as expected, indicating that athletes with higher
COVID-19 fears had significantly higher CAS-EA scores.
The positive correlations with related scales ensured thecriterion linkage validity of the CAS-EA.

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Examination of construct validity
Spielberger’s theory indicated that people with higher Atrait felt more threatened in psychological stress, where personal validity is assessed, than in physical stress [11]. The“Sport” and “Athlete value” of the CAS-EA are related tomotivation as an athlete, relationships with others, andevaluation by others. As such, they are similar to psychological stress, in which an individual’s aptitude is evaluated. On
the other hand, the “Restrictions” and “Practice” relate to
the restrictions of COVID-19 disasters and are similar tophysical stress. Therefore, “Sport” and “Athlete value”
may have correlated more strongly with A-Trait (Table 3)than other factors. Furthermore, the Japan specific background of the COVID-19 pandemic was the declaration ofa state of emergency without mandatory lockdown. As aresult, the Japanese government urged its citizens to avoid
unnecessary outings, limit contact with others, and adopt
a policy of social distancing [14]. However, since the declaration of a state of emergency was a request and not a mandate, it depended primarily on the Japanese people’s
awareness and self-control [15]. This required the Japanese
to demand strict ethical standards for themselves andothers. Uricher et al. [16] conducted a cross-cultural study
to determine whether cultural background was related topeople’s behavior during COVID-19 pandemic. They
reported that Japanese participants demanded higher levels
of infection prevention behavior from themselves and thosearound them and imposed stricter ethical standards thanUS participants. Thus, the synergistic effect of Spielberger’s
theory and Japan-specific background in which the
response to the COVID-19 pandemic depended on the
self-control of each individual citizen may have resulted
in a stronger relationship between psychological stressand A-Trait than physical stress. COVID-19 has been
expanding and converging, and there is no telling when
the next outbreak will occur. During the period of
COVID-19 infection spread, Japanese athletes may be particularly demanding of themselves and those around themin terms of strict ethical standards. These results indicatedthat athletes with anxious temperaments are at higher riskfor psychological stress (such as being evaluated forcorrectness).
In addition, several previous studies have shown thatfemale is more anxious than male in the COVID-19 disaster[17], and our study showed similar results (Table 5). On theother hand, when CAS-EA scores were compared sports
type, significant differences were found only for the “Practice”, but not for the total score. There are no consistent
results regarding comparisons sports type. Fiorilli et al.
found that athletes in individual sports have higher psychological stress than athletes in team sports [18], while BatallaGavalda et al. reported that team sport athletes had greater
overall mood disorders, nervousness, and depression thanSports Psychiatry. 2024;3(2):63–69

individual sport athletes [19]. In addition, Rubio et al.
reported that team athletes adapted to COVID-19 disasters
more quickly than individual sport athletes [20]. The resultsof this previous study may explain the higher scores on the“Practice” for individual sport athletes in present study.
However given the overwhelmingly small number of teamsport athletes in this study, the number of subjects needs
to be increased and a re-examination conducted.
As described above, the findings of this study do not contradict Spielberger’s Trait-state anxiety theory and previous
studies on sex differences. Therefore, we argue that thesefindings contribute to confirming the criterion linkage
validity and construct validity of the CAS-EA. The resultsof this study showed that some athletes had COVID-19 anxiety even after COVID-19, suggesting high-risk factors suchas anxious temperament and female. Support staff needs tokeep this in mind when providing support.

Limitations
The most important thing to emphasize is that team sport
athletes are much less likely than individual sport athletes.
A study conducted by Melnyk et al. reported that individual
sport athletes had less social well-being compared to teamsport athletes, and them sport athletes had less psychological well-being compared to individual sport athletes [21].
Since the anxiety factors and anxiety intensity may differ
depending on the sports type, it is necessary to continue
the survey by increasing the sample of team sport athletes
in the future.

Conclusion
This study was conducted to develop a scale to measureanxiety about COVID-19 among Japanese elite athletes
and to examine its validity and reliability. Scale items wererefined in Study 1, and reliability and validity were examined in Study 2. Based on these results, the CAS-EA ensured
a certain degree of reliability and validity as a scale to measure Japanese elite athletes’ anxiety tendency regarding the
COVID-19. We hope that the results of this study will help
athletes cope with their anxiety when unprecedented life
events stand in the way of their careers.

Electronic Supplementary Materials
The following electronic supplementary material is available with this article at https://doi.org/10.1024/26740052/a000080.
ESM 1. CAS-EA draft version, 35 items.

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History
Received January 14, 2024
Accepted April 11, 2024
Published online April 24, 2024
Conflict of interest
The authors declare no conflict of interest.
ORCID
Kanami Suzuki
https://orcid.org/0009-0002-4349-1199
Tatsuya Yamaguchi
https://orcid.org/0000-0002-4870-0140
Yasuhisa Tachiya
https://orcid.org/0009-0009-6933-4918
Kohei Nakajima
https://orcid.org/0009-0008-6454-0387
Kanami Suzuki, M.P.Ed.
Sport Clinic
Japan Institute of Sports Sciences
3-15-1 Nishigaoka
Kita-ku, Tokyo 115-0051
Japankanami_suzuki1205@yahoo.co.jp

Ó 2024 The Author(s) Distributed as a Hogrefe OpenMind article
under the license CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0)

Sports Psychiatry. 2024;3(2):63–69